Jaundice and formula/breastfeeding

[Alikhlas]

Originally Posted by z2akids Elevated levels of bilirubin can be very dangerous. High enough levels for long enough can cause permanent neurological damage. Jaundice needs to be taken very seriously for the ultimate health of the child. Babies with jaundice become very sleepy as a result. This means that they often are very poor nursers. Keeping them awake long enough to get sufficient breastmilk in those early days can be very tough to do. Breastmilk is also digested more fully than formula which means that those babies often have fewer and smaller bowel movements than babies on formula which means that formula fed babies generally clear the bilirubin from their bodies more quickly than breastfed babies (which is good for baby). Latch problems can be common and part of the reason is that baby is too sleepy to get and keep a good latch. Pumping can be an alternative that works for a lot of people. I addition, sunlight or biliblankets help breakdown the bilirubin so that it can be excreted. Switching to formula is fairly standard advice because of how dangerous longterm exposure to high levels of bilirubin can be. It is absolutely possible to breastfeed your way through jaundice and for baby to be fine. But, please don't just dismiss the advice as bad advice. My middle child had a borderline bili level when we left the hospital. We went to the doctor about 36 hours later and his level was higher. We were advised to get him in the sun and nurse as much as possible (or supplement). His levels continued to rise for the next day or two and ultimately we had to use a biliblanket on him 24/7 at home for 5 days with a visiting nurse coming in daily to do a heel stick to check his levels. We got through it without supplementing. However, it was something that we continually reevaluated because if my milk hadn't come in quickly and if we couldn't keep him awake enough to nurse or he wasn't having enough bm's, then we knew that supplementing may well be more important for his longterm health than exclusively breastfeeding. We were careful to stick with advice from our doctor, LC and the information we received from daily bili level information. It isn't necessarily bad advice that she is getting and certainly shouldn't just be blown off as an ignorant doctor.

Very good post.

I guess sometimes med professionals cut to the chase too soon and don't take the time to explain what's going on ton the patient. That could be good or bad, depending on the ppl and situation, but in these cases it could mean a mother foregoing bf'ing altogether.

[DesertRat]

It really bothers me how quick some doctors are to suggest a "remedy" that could easily sabotage a brand new breastfeeding relationship. I understand the dangers of high bili levels, but the first few days of breastfeeding are crucial. Not only is the baby likely to develop nipple confusion switching from breast to bottle, but mom's milk isn't going to come in very well if the baby isn't nursing CONSTANTLY. And it just KILLS me every time I hear a new mom say she doesn't make enough milk, only to find out the first few days the baby got several bottles of formula.

For me, my response would depend entirely on how high the levels were and how quickly my milk comes in. A couple of my babies had "moderately high" bili levels, but my milk came in quickly and I put them in the sun as often as possible. My babies were fine. Doctors act like formula is the only way to get rid of the bili, but as long as the baby is getting milk, he's going to be fine.

If the bili levels were high, I would insist on using those bili lights first and then use the straw nipple thing others mentioned. Only as a last resort would I give my baby a bottle.

[7 for now]

I had an aortic valve replacement 8 years ago with a donated human valve. As a result my last 4 babies since the replacement have had serious jaundice. This is due to some weird antibodies I now make as a result of the human valve. I am not talking borderline or med levels, but high levels of bilirubin.

They have all had to be on home phototherapy or 1-2 weeks. I have NEVER given them formula to hurry it along. My milk was in by day 2-3 and is much better nutrition than formula. My ped only suggested it once and I shot him down quickly. I am not an uneducated mom, I am a pediatric nurse.

The reason they say they get over it quicker with formula is because they poo more with formula because there is so much undigestable stuff in it that it creates much more waste than breast milk which is much more digestable. I am not willing to do that to my baby for a quicker Recovery of jaundice. We just nursed as much as they would. We would undress to rouse If need be.

I think too many pediatricians are quick to say formula.

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[abunchoflemons]

Sounds like my docs with my oldest. My oldest had horrible latch & all. Tell her to go get lactation, lll support as well. I think my lack & all made it harder to bf but I was in college so not sure when I would have pumped & all.

[Suzi]

My hospital and doctor really encouraged my bfing even tho my son was a little jaundice. We went home after 3 days and a nurse came to our house 36 hours later and my sons bill levels were dangerously high, 27. He was readmitted to the hospital put under the lights and they got an I've going. He has some general global delays but overall is ok.

I wish someone had given me some options. We ended up cup feeding while I continued to work at bfing (and he had the iv for a week). When he was a month old I gave up and bottle fed my bm. It took until he was 6 months old for him to not look orange

[Alikhlas]

I just heard from the mom. They're taking her back to the hospital bc her levels are higher now :/

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[KelseyH]

DS was severely jaundiced and on a bili light at home for two weeks (or more.. Can't remember exactly). He was as yellow as they come, but before the pediatrician could even say anything after "jaundice" I told her there was NO WAY my son was getting one single drop of formula. Not a drop.

So I nursed for 20, 30, 40 minutes or more at a time and pumped after EVERY. SINGLE. feeding - even the 2 a.m. ones, THAT sucked - for two weeks, until his bili levels were normal and his weight was above birth weight.

DH or my mom would give the bottle from the previous pumping session while I pumped for the next feeding. It was absolutely exhausting. I remember going to bed at 6 pm and crying when I had to get up and nurse AND pump because I was so exhausted and DS wouldn't latch because he was so lethargic. But it was SO worth every minute to me because I can say my son was EBF from day 1 and never, ever had any formula. (and once we stopped supplementing with pumped bm, it didn't take long at all to build up a huge stash! )

[Alikhlas]

Originally Posted by KelseyH DS was severely jaundiced and on a bili light at home for two weeks (or more.. Can't remember exactly). He was as yellow as they come, but before the pediatrician could even say anything after "jaundice" I told her there was NO WAY my son was getting one single drop of formula. Not a drop. So I nursed for 20, 30, 40 minutes or more at a time and pumped after EVERY. SINGLE. feeding - even the 2 a.m. ones, THAT sucked - for two weeks, until his bili levels were normal and his weight was above birth weight. DH or my mom would give the bottle from the previous pumping session while I pumped for the next feeding. It was absolutely exhausting. I remember going to bed at 6 pm and crying when I had to get up and nurse AND pump because I was so exhausted and DS wouldn't latch because he was so lethargic. But it was SO worth every minute to me because I can say my son was EBF from day 1 and never, ever had any formula. (and once we stopped supplementing with pumped bm, it didn't take long at all to build up a huge stash! )

That's awesome mama!

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[z2akids]

OP, I am sorry to read that the LO has to go back to the hospital. One thing to remember is that the faster baby gets rid of the bili, the faster she will be more alert and more able to stay awake to latch. So, it may well be that a little formula may actually speed mom and baby's ability to form a long lasting breastfeeding relationship. Just another way of looking at it. Hopefully in the hospital she will find good support from the N/PICU staff to help her pump and feed that to baby and they will have LCs on staff to help her with baby's lethargy and rebuilding that breastfeeding relationship.

But, more important than that is that baby is being treated!

Originally Posted by KelseyH DS was severely jaundiced and on a bili light at home for two weeks (or more.. Can't remember exactly). He was as yellow as they come, but before the pediatrician could even say anything after "jaundice" I told her there was NO WAY my son was getting one single drop of formula. Not a drop. So I nursed for 20, 30, 40 minutes or more at a time and pumped after EVERY. SINGLE. feeding - even the 2 a.m. ones, THAT sucked - for two weeks, until his bili levels were normal and his weight was above birth weight. DH or my mom would give the bottle from the previous pumping session while I pumped for the next feeding. It was absolutely exhausting. I remember going to bed at 6 pm and crying when I had to get up and nurse AND pump because I was so exhausted and DS wouldn't latch because he was so lethargic. But it was SO worth every minute to me because I can say my son was EBF from day 1 and never, ever had any formula. (and once we stopped supplementing with pumped bm, it didn't take long at all to build up a huge stash! )

It is stories like these that always make me wonder. I was very fortunate to have been able to EBF each of my children, even my middle who wore a biliblanket and I had to pump while I was back at the hospital with a spinal headache. But, I never felt like it was a contest and often I read posts where it seems like people feel it is. Yay - I was crying and so exhausted that I was in bed at 6 and my mother and DH had to take care of my newborn for me -- but he never got formula. I don't think I would have made that trade off.

[DesertRat]

Originally Posted by z2akids It is stories like these that always make me wonder. I was very fortunate to have been able to EBF each of my children, even my middle who wore a biliblanket and I had to pump while I was back at the hospital with a spinal headache. But, I never felt like it was a contest and often I read posts where it seems like people feel it is. Yay - I was crying and so exhausted that I was in bed at 6 and my mother and DH had to take care of my newborn for me -- but he never got formula. I don't think I would have made that trade off.

I totally understand what you're saying. But to some degree, I think breastfeeding moms almost have to have this "do or die" mentality about breastfeeding. The first few weeks are really hard. It's going to be so tempting to give in and give a bottle, or whatever. But I don't think enough moms realize that a) it gets easier after a few weeks and that b) every bottle the baby gets has the potential to adversely affect breastfeeding. I know so many women who sincerely wanted to breastfeed but who didn't realize that some of the choices they made in the first few days/weeks set them up for failure.